275202591-1-5-2024-24-AS-BCHN-D4WUTQ-20240503155216

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 275202591
Report Date: 01/04/2024
Date Signed: 01/05/2024 09:56:18 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/15/2023 and conducted by Evaluator David Ayers

COMPLAINT CONTROL NUMBER: 24-AS-20231115122107

FACILITY NAME:	MERRILL GARDENS AT MONTEREY		FACILITY NUMBER:	275202591
ADMINISTRATOR:	TIFFANEY SANTORO		FACILITY TYPE:	740
ADDRESS:	200 IRIS CANYON RD		TELEPHONE:	(831) 250-0930
CITY:	MONTEREY	STATE: CA	ZIP CODE:	93940
CAPACITY:	150	CENSUS: 114	DATE:	01/04/2024
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Tiffaney Santoro - Executive Director		TIME COMPLETED:	03:55 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff are not assisting residents with activities of daily living
Facility staff are not meeting the needs of residents in care

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 1/4/2023, Licensing Program Analyst (LPA) D. Ayers conducted an unannounced complaint inspection. LPA met with Executive Director Tiffaney Santoro announced the purpose of the inspection. The purpose of this visit is to deliver the finding of the investigation completed by the Department. During the course of the investigation, the department inspected the facility, conducted interviews, and reviewed records. The following allegations have been determined to be Substantiated.

1. Facility staff are not assisting residents with activities of daily living: Based off of interviews, facility staff have stated that they were advised by facility administration that they are not required to assist residents with eating. Responsible parties for residents in care and other witnesses have been told by facility staff that the facility does not assist residents with feeding, and that California Code of Regulations Title 22 does not require or allow Residential Care Facilties for the Elderly(RCFE) to assist residents with eating.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: David Ayers	TELEPHONE: 559-498-4163
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 24-AS-20231115122107

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: MERRILL GARDENS AT MONTEREY	FACILITY NUMBER: 275202591
	VISIT DATE: 01/04/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

2. Facility staff are not meeting the needs of residents in care: based off of records reviewed, although facility residents have been assessed by facility staff as needing assistance with dining services, which includes assistance eating, facility staff are not always providing such assistance.

Based observations, records reviewed, and interviews, the preponderance of evidence standard has been met; therefore, the above allegations are found to be substantiated at this time. Per the California Code of Regulations (CCR), Title 22, Division 6, Chapter 8, the following deficiencies were observed and cited on the attached LIC 9099-D. Failure to correct the deficiency may result in civil penalties.
An exit interview was conducted, and a copy of this report provided to the licensee via email. Appeal Rights (LIC 9058) were provided to the licensee.

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: David Ayers	TELEPHONE: 559-498-4163
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 24-AS-20231115122107

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: MERRILL GARDENS AT MONTEREY	FACILITY NUMBER: 275202591
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/04/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/12/2024 Section Cited CCR 87464(f)(4)	1 2 3 4 5 6 7	87464 Basic Services: (f)(4) Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal, with those activities of daily living such as dressing, eating, bathing and assistance with taking prescribed medications...This requirement was not met as evidenced by	1 2 3 4 5 6 7	Executive Director agreed to provide staff training on Title 22 requirements for assistance with activities of daily living.
	8 9 10 11 12 13 14	Based on interviews and records review, the licensee failed to ensure that at least one out of 114 residents was provide necessary assistance with activities of daily living, which presents a risk to the health and safety of residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: David Ayers	TELEPHONE: 559-498-4163
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 3